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Out Alive is a podcast about real people who survived the unsurvivable. Check out more seasons and episodes here.
This episode contains graphic content that may not be suitable for all listeners.
Peter Agricola was mountain biking near his home in Norfolk, Massachusetts when he went over the handlebars on a downhill and landed chest-first on a downed log. As he sat up he saw that he was bleeding profusely, soaking his shirt. He had impaled himself in the chest by a branch.
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Host: Just a warning that this episode contains graphic content and may not be suitable for all listeners.
I didn’t realize how badly I was hurt. These are words my co-producer, Zoe, and I hear all the time when we ask people to tell us their survival stories. You might remember climber Derek Cheng from a few episodes ago.
Derek Cheng: Maybe naively didn’t think of what is the worst-case scenario here. Might I have, for example, a brain bleed, which I actually had. I didn’t know that until much later, so I felt okay, even though later hospital scans will reveal that you are actually really fucked up.
Host: There are physiological explanations for why we don’t immediately recognize the extent of our injuries, like the surge of adrenaline that kicks your body into survival mode.
Your brain also begins to release endorphins, which are natural painkillers. To understand this dynamic better, we called an expert.
Alison Roy: My name is Dr. Allison Roy. I’m a licensed clinical psychologist.
Host: You might remember Allison from last season’s episode when she and her husband, Ian, shared their family’s experience of being attacked by a rabid coyote.
Alison Roy: I’ve really spent my career focusing on the study and treatment of trauma and PTSD, which is Post Traumatic Stress Disorder, as well as just really understanding the body and brain’s response to stress and overwhelming the stressful events. So when we experience something life-threatening or a survival situation, our brain does what it knows to do best. It goes into this survival mode. It regresses down into the most basic or reptilian part of our brain, and really that part of our brain’s only job is to keep us alive.
Host: So in dire circumstances, your brain reallocates resources so that your only focus is on survival. You don’t notice the pain because, in that moment, it’s just not important.
Certain brain functions begin to shut down: impulse control, higher order reasoning, even language and memory storing. All in the interest of conserving energy.
Alison Roy: The brain also protects us from emotional trauma, and so it switches into a survival mode of “I’m going to protect you from what you’ve been through and not allow you to process that all at once because it’d be too much.”
So, denial’s really powerful. When we’ve been through something and maybe we want to not believe our injuries are as severe as they are, or not want to hear or understand that we may not be able to give back to doing the things that we love right away, our body creates that denial defense in order to protect us as well.
So the brain and the body are amazing machines that are capable of so many different feats in the world of survival, and sometimes that creates circumstances for us after we experience an overwhelming event that doesn’t allow us to fully be engaged in what’s actually happening to us.
Host: Which means that denial is a normal response and one of the best ways our brain tries to shield us from the too-much-too-sooness of an ordeal.
This is exactly what happened to Peter Agricola, the subject of today’s story. After a serious accident, he assumed he’d be back on the trails in days. It was only as time passed and his defense mechanisms relaxed that he started to truly understand the extent of his injuries.
Trailer: I made a decision to survive. You’re in that survival mode. The idea of dying wasn’t in my head. I knew immediately it was the worst-case scenario. I was in a fight-for-my-life situation. Whenever you walk out on these trails, you’re in their house. I’m Louisa Albanese, and you’re listening to Out Alive by Backpacker.
In each episode of this podcast, we’ll bring you real stories of real people who survived the unsurvivable. I saw the rope zip through the repel ring, and I couldn’t do anything. Learn what went wrong, what went right, and how you can escape if the worst-case scenario happens to you. There is no way we would find anybody alive.
Peter Agricola: My name is Peter Agricola. I’m 56. I’m from Norfolk, Massachusetts. I’ve got three kids. I’m a big skier, a big mountain biker. I just enjoy the outdoors and try and spend as much time outdoors as I possibly can. I started mountain biking when I was 22 after college, and it became a passion of mine. I always used to say I was a skier who mountain biked, but based on the amount of mountain biking I did, it turned out that I was a mountain biker who skied.
Host: Peter continued mountain biking as he got older, even as his three kids were born and were growing up.
Peter Agricola: At the time I was 44 years old, I had a 10-, a 9-, and a 5-year-old at home.
So we had tons going on, and so it was just one of these crazy typical suburban parent weekends, which we love, lots of energy and stuff like that. So on Sunday, I was gonna set up for a mountain bike ride early. I was going to my local track, and I liked it because it was a really challenging track.
It’s close to the house; I could do it during lunch, so I was by myself, early Sunday morning. So there were really very few people on the trail, which is the way I like it.
Host: Peter’s ride took him through a local state forest, which offered plenty of single track through dense trees. It was a trail he’d done literally hundreds of times before.
Peter Agricola: I was riding, riding fast. Pretty happy with the way things were going. It was a beautiful Sunday morning, all that good stuff. I came to a downhill section. I’m flying down this, no brakes, had pedaled into it, so I was going very fast. There was a trench that was there, and the trench normally was about 12 inches deep.
But because we had had a lot of rain earlier in the week, it was probably about 24 inches. I was hammering down there and right in the middle of it—it’s probably about a 100-yard section right in the middle of that—I road through it, and the front end of my bike jammed into it. Basically, the trench stopped all of my momentum.
And so it stopped the momentum of the bike, but it didn’t stop the momentum of me, and so the momentum of me went over the handlebars, ended up supermanning off the bike. I went out basically chest first, arms out, trying to protect myself. If I were to guess, I probably went 10 to 12 feet from where the trench was to where the log that I landed on was.
And that log had a branch sticking out of it. That branch is what ultimately went into my chest. That’s what impaled me, and when I landed, just a tremendous amount of pain. If that branch hadn’t been there, I probably would’ve just broken some ribs because that branch went so deep into my chest. It ended up going far enough in there to puncture my lung and break my ribs. That branch went almost 4 inches into my chest.
Host: Peter had been impaled pretty much in the center of his pectoral muscle, but due to the shock of the fall, he had no idea and assumed he’d broken his shoulder instead.
Peter Agricola: I sat up with my butt against the log trying to catch my breath. I lost my wind and my shoulder really hurt.
I was thinking, “Damn, what am I gonna do here?” And I looked down at my shirt. I was wearing an Under Armor white top with short blue sleeves, and I looked down to my left, right above my heart, and I had a huge red spot blossoming there, and it was getting bigger by the second. I realized at that point that I was bleeding profusely, and then I started to freak out a little bit.
I’m like, “Shit, what am I gonna do?” I didn’t know I had impaled myself at that point. I knew I needed help, so I got up. I was in an area that I know really well, so I knew I could get out. I knew my way out of there, but there’s no way I could ride the bike at that point. So I left my bike on the side of the trail, which was no small deal.
Still had my helmet on, still had my CamelBak on. As I started to walk, I was going up some uphill and my breathing started to become really labored.
Host: At the time, without knowing the extent of his injuries, it didn’t occur to Peter to call 911, so he called the one person he could think of to help him out.
Peter Agricola: And so I called my wife, which was dumb. Wouldn’t didn’t do me any good, and it freaked her out. I said, “Mel, it’s Pete. I had a bad biking accident. I landed on my chest and I’m in a lot of trouble and I need help.” I didn’t know the degree of injury. I knew it was a lot of blood, but I didn’t really want to panic her at that point.
I’m pretty sure she was panicked. It’s not, it’s 8:45 on a Sunday morning, your husband calls and says he needs help. That was really the context of the call, so she in turn ended up calling 911.
Host: Meanwhile, Peter continued to make his way toward the trailhead on foot.
Peter Agricola: Off this single-track, you end up hitting some carriage trails.
My plan was to get out the woods, hike back up to my car, and there was a state police barracks up the road and see if they could give me some help. In turn, she had called 911 and told them where I was. They were going to try and meet me somewhere on the carriage trails. I got onto the carriage trail and at that point my breathing was really labored.
Blood was just pouring down my shirt and it was white, so it was almost, it was down below my ribs. I started walking up and I saw a guy walking his dog, and he looked at me and he said, “What are you doing?” And I said, “I’m going to my car.” I took my hand away from my chest and he said, “No, you’re not. How about we turn around?”
And he brought me to a place that was downhill versus going uphill, and he ended up calling 911 again saying, “Hey look, I’ve got the guy that you’re gonna pick up in Foxborough, and this is where we think we’re gonna be.” So we started walking down this path, which was really rocky. I had clip in pedals and it wasn’t necessarily the easiest thing I’ve ever done physically, but this guy kept on talking to me and asked me who I was, where I was from, what was going on, which was a real comfort to me.
Starting to get more and more freaked out by the minute. I said to him, “I wanna lie down.” He goes, “Oh, we’re only a couple minutes away from getting rescued.” It wasn’t a couple minutes, it was more like 10. But his encouragement kept me going.
Host: Peter stumbled along for a few more minutes until they met a truck from the Foxborough Emergency Department that had made its way up the carriage road.
Peter Agricola: They sent a bunch of guys, and they were great guys and they’re like, “Have you looked at your wound?” And I said, “No.” They said, “Don’t.” Okay. So I said, “Okay, that makes sense.” They tried to put me in the truck so they could drive me to the ambulance because it was another, it was probably another half-mile. I still had my bike helmet on, and I don’t know if you’ve ever seen people get arrested before, how they push people’s heads down? They do that so you don’t bump your head on the doorjam in the car. Nobody did that for me and I also had the helmet on. So I smacked my head into the door jam of the truck, and I fell back onto the rock. On the trail and it hurt a lot, but we laughed and we decided that maybe we could walk the rest of the way.
So we walked the rest of the way to the ambulance, and they were there with the EMTs. They immediately put me in the ambulance. They put me on oxygen. They would not give me any painkillers because it turned out my blood pressure was really messed up and they thought that might put me into cardiac arrest.
Again, great guys, gave me the oxygen, checking my vitals, and got me down to Rhode Island Hospital.
Host: Though only a half hour ride, it felt like an eternity for Peter. Every bump in the road caused excruciating pain in his chest.
Peter Agricola: They were at that point able to call my wife and tell her where I was gonna be so she could come visit me, and they brought me down to Rhode Island Hospital.
But when I got there, in my mind I thought, “Oh, they’ll patch me up and I’ll be mountain biking again by Tuesday.” But then they left me in my room for almost a half hour, or it seemed like a half hour. So again, I thought nothing bad was going on at this point. The adrenaline had worn off.
I was starting to go into shock, and the pain was starting to become really intense. Every time I heard a female voice, I thought it was gonna be my wife. I just wanted somebody in the room with me just to comfort me at that point. She finally arrived, probably about an hour later. They had a resident checking me out, checking my vital signs, and then they started cutting off all my clothes.
Here I am completely naked, bleeding, bleeding profusely in the hospital, and wasn’t all that happy about it. Again, the resident came in, the attendant came in. That’s when, in my mind, the shit hit the fan. The pain was just excruciating. I couldn’t go to the bathroom, and I just started to cry.
My wife was holding my arm, and she asked what was going on. I’ve just never been in this kind of pain in my life before. I could barely breathe.
Host: We’ll be right back.
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Peter was left with a 4-inch-deep wound where the branch had entered his chest. It had come less than half an inch away from his heart.
Peter Agricola: I was still bleeding quite a bit at that point, and that’s when panic sent in a little bit. So they put me in for a CAT scan and they took a picture of my chest and lungs.
They brought me back into the room and it went from 0 to 100 in two seconds. They’re like, “All right, here’s the deal. You’ve got blood in your chest, we need to put in a chest tube.” And they said to my wife, “You need to leave.” And she said, “Okay, I’ll leave the room.”
They said, “No, you need to leave the hospital.” I didn’t really understand why they were telling her to leave the hospital until the process of putting the chest tube in. So if you’re not familiar with the chest tube, it looks like the tip of an arrow attached to a tube. They take that arrow, if you will, which is a scalpel, and they stick it in your lap between a couple of ribs and they shove that all the way into your chest about 5 inches.
And what that’s designed to do is to start taking the blood out of your chest.
Host: Three nurses and two doctors strap down Peter’s arms and legs and then held him to the bed.
Peter Agricola: And the nurse who was in there whispered in my ear, she said, “This will be the most painful thing that you’ve ever gone through.” And then she goes, “I’ve had twins. I’ve had a chest tube. I’d have twins over a chest tube any day of the week.” She was not lying. It was incredibly painful. Alls I can remember yelling is, “You need to stop. You need to stop. You need to stop.” I didn’t have any painkillers on board. Again, because I mentioned before, my blood pressure was fluctuating and they were afraid that if they gave me painkillers at that point that I could go into cardiac arrest.
They got it in and that was great. They unstrap me and that’s when they finally were able to give me some pain killers. It made a tremendous amount of difference for pain, as painkillers are designed to do. Then at that point, they let my wife back in. They said, “We’re gonna admit him. We’ll check his vitals and stuff like that.”
So they put me in a room on the trauma floor.
Host: Even through all the pain, Peter didn’t quite understand the extent of his injuries. Since they drained his chest. He thought they’d stitch him up, and he’d be back on his bike in no time.
Peter Agricola: They’re gonna get the blood out of my chest, they’re gonna stitch my chest up, I’ll be mountain biking in no time.
So as the day went on, they were, they were continuing to give me more and more painkillers. I went to the bathroom about midnight, and I looked down, and I had blood all over the place. I didn’t say anything. I didn’t ring the nurse call button, but when they checked on me at about 5 in the morning, they were like, “Oh boy, this is not good.”
So they cleaned me up, all that good stuff. I had finally fallen asleep. The next thing I knew, there were eight doctors around my bed. They said we need to perform surgery right away.
Host: Even still, Peter was in denial about his situation.
Peter Agricola: I don’t need surgery. I wanna go mountain biking later in the week. That wasn’t to be. They basically said, “What’s happening is we can’t stem the source of the bleeding in your chest. There’s a ton of blood pooling up there and the chest tube is just removing the blood, but it’s not removing enough of the blood.” They needed to find the source of the bleeding.
And again, I’m freaking out. I wanted my wife there, and I say, “Can you at least just call my wife and let her know what’s going on?” And they called her, and she was in the produce aisle of the local shopping center with my youngest son, so she’s got to find care for him.
Host: Peter had two serious and potentially life-threatening conditions. Hemothorax, which was the blood pooling in his chest, and also a pneumothorax, which meant there was air leaking from his lungs into his chest cavity. The combination of these two conditions is known as a hemopneumothorax or hemopneumo for short.
Peter Agricola: They brought me down for surgery. What they ended up doing was they put a laparoscope in my back so they could look in and they could find the source of the bleeding. The source of the bleeding was I had perforated my pulmonary vein. That was just spewing blood into my chest. So they went in and they repaired that.
I also punctured my lung and had actually put a hole through it with a branch. Not only did I have blood in my chest, but I had air in my chest. That’s a really bad combination. Most people do not survive that. The other injuries that I had acquired were the five top ribs in my upper chest were broken in half, so they were displaced, so they were bent inward, so they were literally broken in half.
So it’s five broken ribs. They were broken in 21 places. I also broke three lower ribs. I had a total of eight broken ribs, and I had essentially dislocated the left side of my chest, but I also had perforated the pericardium. And the pericardium is a sac that your heart sits in, and after I was out of the hospital, the doctor said if it had gone about a half a centimeter more, it would’ve punctured your heart and you would’ve died on the trail.
Host: Peter had lost almost 60 percent of his blood, which doctors replenished with two separate transfusions. After surgery, two transfusions, two chest tubes, and eight broken ribs. Peter was left with a gaping wound and a long road to recovery.
Peter Agricola: So you heal from the inside out. What they actually do is they stuff gauze into your wound, as much gauze as they can, and then they take that out every day, and they redress it every day.
It was a pretty cool process, if you don’t mind blood, and I don’t mind blood. It was very bizarre. The pain level was really high and they were giving me morphine, which worked for a while. But about the second day, I started having really bad hallucinations. It felt like I was sinking in my bed like it was filled with sand, all this other stuff, not necessarily on top of everything else. Hallucinations were not necessarily what I was looking for. They were able to figure it out, and they changed it. They changed my medicine from morphine to something different and they were also able to give me an anti-anxiety pill to minimize that.
As time went on, I started to get more and more antsy, very antsy by nature, and started to get more and more pissed. I’m a really, really bad patient and I really thank the nurses for hanging out. On the third day, I called my wife and I said, “These are the things that I wanted.” I wanted an Oxford shirt, a button-down shirt that I could put on easily, a couple bagels, tea, coffee, a bunch of other things. And my wife referred to it as the Angry Bear List. She’s like, “We’d known each other for 20+ years.” She goes, “I’ve never seen you drink a cup of tea in your entire life, and you’re asking for tea.” I didn’t even, I pretty much didn’t need anything that she brought me, but she did bring the Oxford shirt, which was nice.
I know that sounds very self-conscious or vain, but when you’re there, you’re just exposed, and people are poking and prodding. That definitely made me feel better, at least from a psychological standpoint. I was in the hospital for a total of, I think, 10 days. At that point. I was really clamoring to get out of there, and they decided to release me.
I was very excited about being released. I couldn’t wait to see my kids. My son had been at a lacrosse game. A friend of mine had brought him home. It was a joyous reunion with all of my kids. They didn’t expect me to be at home, but here I was with a giant, with a giant wound in my chest at home.
Host: To aid in his recovery, Peter would need his wound dressing changed daily by a visiting nurse, but on the first day, the nurse wasn’t available.
Peter Agricola: So my sister-in-law, who is a trauma nurse, came down with her medical kit. She took one look at my chest and she said, “No, I can’t do it. I don’t have the right tools.” So thankfully, one of our neighbors is an ER doctor, and my wife called her.
So she came over, and she dressed the wound and she had said, “You shouldn’t be out of the hospital this early,” but she dressed it that day. I had a visiting nurse, so she came to the house every day for 55 days and dressed my wounds.
Host: That first day in the hospital, Peter thought he’d be back on the trails by the following week, but it was months before he was back to normal.
Peter Agricola: At a little bit more than four weeks, I was able to ride my road bike on my wind trainer and I did that for about a week. It was really painful, but I was able to start to be able to do that, and a week after that I actually got on a road ride. Still with the bandages on my chest, but was able to ride my road bike for a short bike ride.
That really started to really help with my recovery psychologically as well as physically. I really had hoped to be on the bike in September. The accident happened on June 6. I wasn’t ready to get back on the mountain bike at that point. On Columbus Day, I was able to go out for my first mountain bike ride.
Slow on a really non-technical track, but was a huge milestone in my recovery. As far as after effects, it probably took me a long time, I think, to realize what had happened to me. I think I was the only person who thought I was going to survive it because it almost felt like I was an outsider looking in.
It was like it was happening to me, but I wasn’t really part of it. But many people have said they assumed I was going to die, and the chances of me dying were pretty high. Again, given the amount of blood loss and the fact that I had a hemopneumo, the Foxborough Police and Fire Department were wonderful. They were great guys. They couldn’t have cared more about it. They had my helmet, so I went and visited, and I brought pizzas to them and a couple of the guys who came and rescued me came out and they said, “We had no idea whether you’re gonna live or die. It’s so nice to see you.”
Because of HIPAA rules, they didn’t know whether I was alive or dead. If I finally realized there are things that I needed to do going forward. I didn’t ride solo for almost nine years after the accident. That was a mutual decision for my wife because again, I was by myself when the accident happened. I still rode pretty hard, but there were definitely some things that still happened, and this is 13 years ago.
There’s definitely some stuff that I still struggle with, at this point, really technical downhills with lots of rock. I do a lot of hike-and-bike at this point. Sometimes it’s just not worth it to me to do it. I sometimes slow down the people that I’m with, but I make it up on the uphills.
I’m gonna take a lesson to help get over that, but there’s just something in the back of my mind that says, “I just don’t want to go over the handlebar again.” So I occasionally go solo, but I really try to go with other people just out of common sense. But I do feel very lucky to be alive. The nice thing is you find that you have a lot of friends and you have a lot of family who are willing to help.
Host: This episode of Out Alive was produced and written by me, Louisa Albanese, along with Zoe Gates. Scoring and Sound Design was by Jason Patton. Thank you to Peter Agricola for sharing your story with us. Thanks to Dr. Allison Roy for sharing your expertise. Thanks for listening to Out Alive.
And if you have a backcountry survival story and you’re interested in sharing, you can email me at firstname.lastname@example.org. Out Alive is made possible by outside plus members. Learn more about all the benefits of membership at outsideonline.com/podplus. Now is a great time to join. We’re offering new members a 50% discount for a limited time and just enter the code OUTALIVE50.